An interventional study of Quasi experimental intervention in Community-acquired Pneumonia, Acute Otitis Media and Pharyngitis, sponsored by Children's Hospital of Philadelphia. Completed at 2 sites in United States. Per ClinicalTrials.gov, last updated 2025-11-14.
Sponsored by Children's Hospital of Philadelphia · Not applicable, Interventional, and Other
The main goal of this study is to use automated electronic reports to assess and improve guideline-concordant antibiotic use for:
1) adult inpatients with community-acquired pneumonia; 2) pediatric inpatients with community-acquired pneumonia; 3) adult outpatients with acute pharyngitis; and 4) pediatric outpatients with acute otitis media.
Antibiotic stewardship has been shown to improve patient outcomes, decrease adverse events, and decrease antibiotic resistance. This group of investigators previously partnered with collaborators at the Centers for Disease Control and Prevention and conducted relevant pilot work in developing and validating electronic indicators of inappropriate antibiotic prescribing for 8 conditions, amongst which are the four conditions of interest in this study: adult inpatients with community-acquired pneumonia; pediatric inpatients with community-acquired pneumonia; adult outpatients with acute pharyngitis; and pediatric outpatients with acute otitis media. Methods were developed to generate automatic, routine reports to identify elements of inappropriate antibiotic use including; 1) the decision to initiate antibiotic therapy (pharyngitis and acute otitis media only); 2) the choice of antibiotic agent; and 3) the duration of antibiotic use.
The purpose of this project is to assess the impact of these developed electronic indicators on supporting antibiotic stewardship efforts to improve the appropriateness of antibiotic use, as well as the acceptability and feasibility of delivering these reports to prescribers. The investigators aim to:
If proven effective, these electronic health record-based approaches hold the promise to greatly enhance the effectiveness and efficiency of antimicrobial stewardship initiatives.
324 studies on the registry are indexed under Community-Acquired Pneumonia; 77 are open to participants now.
This study's enrollment of 26,139 is above the median of 250 across 195 interventional studies indexed under Community-Acquired Pneumonia.
Browse Community-Acquired Pneumonia studies →Children's Hospital of Philadelphia is the lead sponsor of 489 studies on the registry; 90 are open to participants now.
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Patient Inclusion Criteria:
Patient Exclusion Criteria:
Clinician Inclusion Criteria:
Clinician Exclusion Criteria:
Four population groups were included in the pre-intervention data: 1) adult inpatients with community acquired pneumonia; 2) pediatric inpatients with community acquired pneumonia; 3) adult outpatients with acute pharyngitis; and 4) pediatric outpatients with acute otitis media
Four population groups were included in the post-intervention data: 1) adult inpatients with community acquired pneumonia; 2) pediatric inpatients with community acquired pneumonia; 3) adult outpatients with acute pharyngitis; and 4) pediatric outpatients with acute otitis media
Other: Quasi experimental intervention
The intervention included clinician education and sharing of audit and feedback reports summarizing antibiotic use metrics for each of the four target conditions with treating clinicians.
Guideline-concordant Antibiotic Use for Adults With Pharyngitis
Count of participants with pharyngitis with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with pharyngitis with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Guideline-concordant Antibiotic Use for Children With Acute Otitis Media
Count of participants with acute otitis media with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with acute otitis media with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Guideline-concordant Antibiotic Use for Adults With Community-acquired Pneumonia
Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Guideline-concordant Antibiotic Use for Children With Community-acquired Pneumonia
Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Guideline-concordant Antibiotic Choice for Adults Hospitalized With Community Acquired Pneumonia
Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic choice. The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Guideline-concordant Antibiotic Duration for Adults Hospitalized With Community Acquired Pneumonia
Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic duration. The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
30-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults
Count of participants with community-acquired pneumonia with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for community acquired pneumonia within 30 days of discharge following index hospitalization for adult community acquired pneumonia. The count of participants with community-acquired pneumonia with a return visit in the outpatient setting was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with a return visit in the outpatient setting.
Time frame: 30 days
30-day Readmissions for Community Acquired Pneumonia in Adults
Count of participants with a readmission for community-acquired pneumonia within 30 days of discharge following an index hospitalization for community-acquired pneumonia. The count of participants with a readmission for community-acquired pneumonia was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with readmissions within 30 days of discharge following an index hospitalization for community-acquired pneumonia.
Time frame: 30 days
Guideline-concordant Antibiotic Choice for Pediatric Community Acquired Pneumonia
Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Guideline-concordant Antibiotic Duration for Pediatric Community Acquired Pneumonia
Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
28-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Children
Count of participants with pediatric community-acquired pneumonia with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pediatric community acquired pneumonia within 28 days of discharge following index hospitalization for pediatric community acquired pneumonia. The count of participants with pediatric community-acquired pneumonia with a return visit in the outpatient setting was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants with a return visit in the outpatient setting.
Time frame: 28 days
28-day Readmissions for Pediatric Community Acquired Pneumonia
Count of participants with a readmission for community-acquired pneumonia within 28 days of discharge following an index hospitalization for community-acquired pneumonia. The count of participants with a readmission for community-acquired pneumonia was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with readmissions within 28 days of discharge following an index hospitalization for community-acquired pneumonia.
Time frame: 28 days
Guideline-concordant Decision to Prescribe Antibiotics for Adult Pharyngitis
Count of participants with pharyngitis for which the decision to prescribe an antibiotic was correct. The count of participants with pharyngitis for which the decision to prescribe an antibiotic was correct was divided by the total number of participants with pharyngitis to generate the percentage of participants for which the decision to prescribe an antibiotic was correct. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Guideline-concordant Antibiotic Choice Adult Pharyngitis
Count of participants with adult pharyngitis with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pharyngitis with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Guideline-concordant Antibiotic Duration for Adult Pharyngitis
Count of participants with adult pharyngitis with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pharyngitis with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
30-day Pharyngitis Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults
Count of participants with adult pharyngitis with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pharyngitis within 30 days of discharge following index hospitalization for adult pharyngitis. The count of participants with pharyngitis with a return visit in the outpatient setting was divided by the total number of participants with pharyngitis to generate the percentage of participants with a return visit in the outpatient setting.
Time frame: 30 days
30-day Deep Neck Space Infection Admission
Count of participants with a readmission for deep neck space infection within 30 days of index encounter for pharyngitis. The count of participants with a readmission for deep neck space infection was divided by the total number of participants with adult pharyngitis to generate the percentage of participants with readmissions for deep neck space infection within 30 days of index encounter for pharyngitis.
Time frame: 30 days
Guideline-concordant Decision to Prescribe Antibiotics for Pediatric Acute Otitis Media
Count of participants with pediatric acute otitis media for which the decision to prescribe an antibiotic was correct. The count of participants with pediatric acute otitis media for which the decision to prescribe an antibiotic was correct was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants for which the decision to prescribe an antibiotic was correct. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Guideline-concordant Antibiotic Choice for Pediatric Acute Otitis Media
Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pediatric acute otitis media visits with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Guideline-concordant Antibiotic Duration for Pediatric Acute Otitis Media
Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
28-day Acute Otitis Media-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care)
Count of participants with pediatric acute otitis media with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pediatric acute otitis media within 28 days of the index acute otitis media encounter. The count of participants with pediatric acute otitis media with a return visit in the outpatient setting was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants with a return visit in the outpatient setting.
Time frame: 28 days
28-day Mastoiditis or Intracranial Infection Admissions
Count of participants with a readmission for mastoiditis or intracranial infection within 28 days of the index encounter for pediatric acute otitis media. The count of participants with a readmission for mastoiditis or intracranial infection was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants with readmissions within 28 days of discharge following an index hospitalization for acute otitis media.
Time frame: 28 days
Guideline-concordant Decision to Not Prescribe Antibiotics for Pediatric Acute Otitis Media
Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for appropriate decision not to prescribe antibiotics. The count of participants with pediatric acute otitis media with an appropriate decision not to prescribe antibiotics was divided by the total number of participants with no antibiotics prescribed to generate the percentage of participants appropriately not prescribed antibiotics for acute otitis media. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Guideline-concordant Decision to Not Prescribe Antibiotics for Adult Pharyngitis
Count of participants with adult pharyngitis with guideline-concordant antibiotic use for appropriate decision not to prescribe antibiotics. The count of participants with adult pharyngitis with an appropriate decision not to prescribe antibiotics was divided by the total number of participants with no antibiotics prescribed to generate the percentage of participants appropriately not prescribed antibiotics for pharyngitis. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
Time frame: Pre-intervention and post-intervention, up to 2 years
Feasibility of Intervention - Outpatient
Feasibility is defined as the extent to which the intervention can be carried out in the clinical setting. The feasibility of intervention measure is the full name of this scale. The feasibility of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more feasible. There are no validated cutoffs for feasibility. The mean total score and standard deviation of the mean total score for all respondents are reported. The feasibility of intervention measure was assessed by a one time survey in the post-intervention time period.
Time frame: One time measure in the post intervention time period
Acceptability of Intervention - Outpatient
Acceptability is defined as how well the intervention was received by the prescribing clinicians. The acceptability of intervention measure is the full name of this scale. The acceptability of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more acceptable. There are no validated cutoffs for acceptability. The mean total score and standard deviation of the mean total score for all respondents are reported. The acceptability of intervention measure was assessed by a one time survey in the post-intervention time period.
Time frame: One time measure in the post intervention time period
Feasibility of Intervention Measure - Inpatient
Feasibility is defined as the extent to which the intervention can be carried out in the clinical setting. The feasibility of intervention measure is the full name of this scale. The feasibility of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more feasible. There are no validated cutoffs for feasibility. The mean total score and standard deviation of the mean total score for all respondents are reported. The feasibility of intervention measure was assessed by a one time survey in the post-intervention time period.
Time frame: One time measure in the post intervention time period
Acceptability of Intervention Measure - Inpatient
Acceptability is defined as how well the intervention was received by the prescribing clinicians. The acceptability of intervention measure is the full name of this scale. The acceptability of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more acceptable. There are no validated cutoffs for acceptability. The mean total score and standard deviation of the mean total score for all respondents are reported. The acceptability of intervention measure was assessed by a one time survey in the post-intervention time period.
Time frame: One time measure in the post intervention time period.
All patients with one or more of the target conditions during the study period were included.
| Milestone | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Started | 12917 | 13222 |
| Adult inpatients with community acquired pneumonia | 305 | 330 |
| Pediatric inpatients with community acquired pneumonia | 413 | 387 |
| Adult outpatients with pharyngitis | 2032 | 3764 |
| Pediatric outpatients with acute otitis media | 10167 | 8741 |
| Completed | 12917 | 13222 |
| Not completed | 0 | 0 |
Count of participants with pharyngitis with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with pharyngitis with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Use for Adults With Pharyngitis | 1458 | 2477 |
Count of participants with acute otitis media with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with acute otitis media with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Use for Children With Acute Otitis Media | 6154 | 6287 |
Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Use for Adults With Community-acquired Pneumonia | 204 | 242 |
Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics (decision to prescribe an antibiotic, antibiotic choice, and antibiotic duration). The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for all three metrics was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for all three metrics. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Use for Children With Community-acquired Pneumonia | 213 | 308 |
Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic choice. The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Choice for Adults Hospitalized With Community Acquired Pneumonia | 268 | 302 |
Count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic duration. The count of participants with community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Duration for Adults Hospitalized With Community Acquired Pneumonia | 230 | 261 |
Count of participants with community-acquired pneumonia with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for community acquired pneumonia within 30 days of discharge following index hospitalization for adult community acquired pneumonia. The count of participants with community-acquired pneumonia with a return visit in the outpatient setting was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with a return visit in the outpatient setting.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| 30-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults | 0 | 0 |
Count of participants with a readmission for community-acquired pneumonia within 30 days of discharge following an index hospitalization for community-acquired pneumonia. The count of participants with a readmission for community-acquired pneumonia was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with readmissions within 30 days of discharge following an index hospitalization for community-acquired pneumonia.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| 30-day Readmissions for Community Acquired Pneumonia in Adults | 13 | 6 |
Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Choice for Pediatric Community Acquired Pneumonia | 394 | 362 |
Count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pediatric community-acquired pneumonia with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Duration for Pediatric Community Acquired Pneumonia | 221 | 322 |
Count of participants with pediatric community-acquired pneumonia with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pediatric community acquired pneumonia within 28 days of discharge following index hospitalization for pediatric community acquired pneumonia. The count of participants with pediatric community-acquired pneumonia with a return visit in the outpatient setting was divided by the total number of participants with pediatric community-acquired pneumonia to generate the percentage of participants with a return visit in the outpatient setting.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| 28-day Community Acquired Pneumonia-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Children | 13 | 20 |
Count of participants with a readmission for community-acquired pneumonia within 28 days of discharge following an index hospitalization for community-acquired pneumonia. The count of participants with a readmission for community-acquired pneumonia was divided by the total number of participants with community-acquired pneumonia to generate the percentage of participants with readmissions within 28 days of discharge following an index hospitalization for community-acquired pneumonia.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| 28-day Readmissions for Pediatric Community Acquired Pneumonia | 8 | 14 |
Count of participants with pharyngitis for which the decision to prescribe an antibiotic was correct. The count of participants with pharyngitis for which the decision to prescribe an antibiotic was correct was divided by the total number of participants with pharyngitis to generate the percentage of participants for which the decision to prescribe an antibiotic was correct. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Decision to Prescribe Antibiotics for Adult Pharyngitis | 1464 | 2492 |
Count of participants with adult pharyngitis with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pharyngitis with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Choice Adult Pharyngitis | 27 | 160 |
Count of participants with adult pharyngitis with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pharyngitis with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pharyngitis to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Duration for Adult Pharyngitis | 31 | 175 |
Count of participants with adult pharyngitis with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pharyngitis within 30 days of discharge following index hospitalization for adult pharyngitis. The count of participants with pharyngitis with a return visit in the outpatient setting was divided by the total number of participants with pharyngitis to generate the percentage of participants with a return visit in the outpatient setting.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| 30-day Pharyngitis Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) in Adults | 291 | 578 |
Count of participants with a readmission for deep neck space infection within 30 days of index encounter for pharyngitis. The count of participants with a readmission for deep neck space infection was divided by the total number of participants with adult pharyngitis to generate the percentage of participants with readmissions for deep neck space infection within 30 days of index encounter for pharyngitis.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| 30-day Deep Neck Space Infection Admission | 0 | 1 |
Count of participants with pediatric acute otitis media for which the decision to prescribe an antibiotic was correct. The count of participants with pediatric acute otitis media for which the decision to prescribe an antibiotic was correct was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants for which the decision to prescribe an antibiotic was correct. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Decision to Prescribe Antibiotics for Pediatric Acute Otitis Media | 9935 | 8547 |
Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for antibiotic choice. The count of participants with pediatric acute otitis media visits with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic choice. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Choice for Pediatric Acute Otitis Media | 7498 | 6828 |
Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for antibiotic duration. The count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for this metric was divided by the total number of participants with pediatric acute otitis media who were prescribed antibiotics to generate the percentage of participants receiving guideline-concordant antibiotic use for antibiotic duration. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Antibiotic Duration for Pediatric Acute Otitis Media | 7565 | 7281 |
Count of participants with pediatric acute otitis media with a return visit in the outpatient setting (emergency department, urgent care, or primary care) for pediatric acute otitis media within 28 days of the index acute otitis media encounter. The count of participants with pediatric acute otitis media with a return visit in the outpatient setting was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants with a return visit in the outpatient setting.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| 28-day Acute Otitis Media-related Outpatient Revisits (Emergency Department, Urgent Care, or Primary Care) | 891 | 756 |
Count of participants with a readmission for mastoiditis or intracranial infection within 28 days of the index encounter for pediatric acute otitis media. The count of participants with a readmission for mastoiditis or intracranial infection was divided by the total number of participants with pediatric acute otitis media to generate the percentage of participants with readmissions within 28 days of discharge following an index hospitalization for acute otitis media.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| 28-day Mastoiditis or Intracranial Infection Admissions | 0 | 0 |
Count of participants with pediatric acute otitis media with guideline-concordant antibiotic use for appropriate decision not to prescribe antibiotics. The count of participants with pediatric acute otitis media with an appropriate decision not to prescribe antibiotics was divided by the total number of participants with no antibiotics prescribed to generate the percentage of participants appropriately not prescribed antibiotics for acute otitis media. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Decision to Not Prescribe Antibiotics for Pediatric Acute Otitis Media | 284 | 292 |
Count of participants with adult pharyngitis with guideline-concordant antibiotic use for appropriate decision not to prescribe antibiotics. The count of participants with adult pharyngitis with an appropriate decision not to prescribe antibiotics was divided by the total number of participants with no antibiotics prescribed to generate the percentage of participants appropriately not prescribed antibiotics for pharyngitis. These proportions were compared for the group of participants in the pre intervention period (1 year) and the post intervention period (1 year). There were not individual participant level measures for this outcome.
| Participants | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period |
|---|---|---|
| Guideline-concordant Decision to Not Prescribe Antibiotics for Adult Pharyngitis | 1432 | 2312 |
Feasibility is defined as the extent to which the intervention can be carried out in the clinical setting. The feasibility of intervention measure is the full name of this scale. The feasibility of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more feasible. There are no validated cutoffs for feasibility. The mean total score and standard deviation of the mean total score for all respondents are reported. The feasibility of intervention measure was assessed by a one time survey in the post-intervention time period.
| units on a scale | Outpatient Clinicians |
|---|---|
| Feasibility of Intervention - Outpatient | 15.7 ± 3.1 |
Acceptability is defined as how well the intervention was received by the prescribing clinicians. The acceptability of intervention measure is the full name of this scale. The acceptability of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more acceptable. There are no validated cutoffs for acceptability. The mean total score and standard deviation of the mean total score for all respondents are reported. The acceptability of intervention measure was assessed by a one time survey in the post-intervention time period.
| units on a scale | Outpatient Clinicians |
|---|---|
| Acceptability of Intervention - Outpatient | 13.4 ± 4.6 |
Feasibility is defined as the extent to which the intervention can be carried out in the clinical setting. The feasibility of intervention measure is the full name of this scale. The feasibility of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more feasible. There are no validated cutoffs for feasibility. The mean total score and standard deviation of the mean total score for all respondents are reported. The feasibility of intervention measure was assessed by a one time survey in the post-intervention time period.
| units on a scale | Preintervention | Postintervention |
|---|---|---|
| Feasibility of Intervention Measure - Inpatient | — | 17.7 ± 3.1 |
Acceptability is defined as how well the intervention was received by the prescribing clinicians. The acceptability of intervention measure is the full name of this scale. The acceptability of intervention scale consists of four questions, each with 5 possible responses (completely disagree, disagree, neither agree or disagree, agree, or completely agree) on a numeric 1-5 scale. These four subscores are summed to generate a total score, with possible scores ranging from 4-20. A higher score indicates that the intervention is more acceptable. There are no validated cutoffs for acceptability. The mean total score and standard deviation of the mean total score for all respondents are reported. The acceptability of intervention measure was assessed by a one time survey in the post-intervention time period.
| units on a scale | Inpatient Clinicians |
|---|---|
| Acceptability of Intervention Measure - Inpatient | 17.2 ± 3.5 |
Collected over This was a minimal risk study deemed exempt research by the CHOP and UPenn IRB. Serious adverse events, non-serious adverse events, and mortality were not collected in this study.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | — | — | — |
| Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | — | — | — |
| Age, Categorical(Participants) | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Total |
|---|---|---|---|
| Total — <=18 years | 10628 | 9177 | 19805 |
| Total — Between 18 and 65 years | 1838 | 3341 | 5179 |
| Total — >=65 years | 451 | 704 | 1155 |
| Adult Inpatients With Community Acquired Pneumonia — <=18 years | 0 | 0 | 0 |
| Adult Inpatients With Community Acquired Pneumonia — Between 18 and 65 years | 173 | 182 | 355 |
| Adult Inpatients With Community Acquired Pneumonia — >=65 years | 132 | 148 | 280 |
| Pediatric Inpatients With Community Acquired Pneumonia — <=18 years | 413 | 387 | 800 |
| Pediatric Inpatients With Community Acquired Pneumonia — Between 18 and 65 years | 0 | 0 | 0 |
| Pediatric Inpatients With Community Acquired Pneumonia — >=65 years | 0 | 0 | 0 |
| Adult Outpatients With Pharyngitis — <=18 years | 48 | 49 | 97 |
| Adult Outpatients With Pharyngitis — Between 18 and 65 years | 1665 | 3159 | 4824 |
| Adult Outpatients With Pharyngitis — >=65 years | 319 | 556 | 875 |
| Pediatric Outpatients With Acute Otitis Media — <=18 years | 10167 | 8741 | 18908 |
| Pediatric Outpatients With Acute Otitis Media — Between 18 and 65 years | 0 | 0 | 0 |
| Pediatric Outpatients With Acute Otitis Media — >=65 years | 0 | 0 | 0 |
| Sex: Female, Male(Participants) | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Total |
|---|---|---|---|
| Total — Female | 6522 | 7215 | 13737 |
| Total — Male | 6395 | 6007 | 12402 |
| Adult Inpatients With Community Acquired Pneumonia — Female | 168 | 178 | 346 |
| Adult Inpatients With Community Acquired Pneumonia — Male | 137 | 152 | 289 |
| Pediatric Inpatients With Community Acquired Pneumonia — Female | 204 | 195 | 399 |
| Pediatric Inpatients With Community Acquired Pneumonia — Male | 209 | 192 | 401 |
| Adult Outpatients With Pharyngitis — Female | 1436 | 2709 | 4145 |
| Adult Outpatients With Pharyngitis — Male | 596 | 1055 | 1651 |
| Pediatric Outpatients With Acute Otitis Media — Female | 4714 | 4132 | 8846 |
| Pediatric Outpatients With Acute Otitis Media — Male | 5453 | 4609 | 10062 |
| Ethnicity (NIH/OMB)(Participants) | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Total |
|---|---|---|---|
| Total — Hispanic or Latino | 889 | 924 | 1813 |
| Total — Not Hispanic or Latino | 11885 | 12020 | 23905 |
| Total — Unknown or Not Reported | 143 | 278 | 421 |
| Adult Inpatients With Community Acquired Pneumonia — Hispanic or Latino | 9 | 9 | 18 |
| Adult Inpatients With Community Acquired Pneumonia — Not Hispanic or Latino | 296 | 320 | 616 |
| Adult Inpatients With Community Acquired Pneumonia — Unknown or Not Reported | 0 | 1 | 1 |
| Pediatric Inpatients With Community Acquired Pneumonia — Hispanic or Latino | 69 | 59 | 128 |
| Pediatric Inpatients With Community Acquired Pneumonia — Not Hispanic or Latino | 339 | 317 | 656 |
| Pediatric Inpatients With Community Acquired Pneumonia — Unknown or Not Reported | 5 | 11 | 16 |
| Adult Outpatients With Pharyngitis — Hispanic or Latino | 101 | 185 | 286 |
| Adult Outpatients With Pharyngitis — Not Hispanic or Latino | 1911 | 3529 | 5440 |
| Adult Outpatients With Pharyngitis — Unknown or Not Reported | 20 | 50 | 70 |
| Pediatric Outpatients With Acute Otitis Media — Hispanic or Latino | 710 | 671 | 1381 |
| Pediatric Outpatients With Acute Otitis Media — Not Hispanic or Latino | 9339 | 7854 | 17193 |
| Pediatric Outpatients With Acute Otitis Media — Unknown or Not Reported | 118 | 216 | 334 |
| Race (NIH/OMB)(Participants) | Pre-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Post-Intervention: Patients Diagnosed With Conditions of Interest During Study Period | Total |
|---|---|---|---|
| Total — American Indian or Alaska Native | 5 | 6 | 11 |
| Total — Asian | 306 | 393 | 699 |
| Total — Native Hawaiian or Other Pacific Islander | 7 | 12 | 19 |
| Total — Black or African American | 1701 | 1825 | 3526 |
| Total — White | 9110 | 9058 | 18168 |
| Total — More than one race | 360 | 391 | 751 |
| Total — Unknown or Not Reported | 1428 | 1537 | 2965 |
| Adult Inpatients With Community Acquired Pneumonia — American Indian or Alaska Native | 0 | 2 | 2 |
| Adult Inpatients With Community Acquired Pneumonia — Asian | 6 | 8 | 14 |
| Adult Inpatients With Community Acquired Pneumonia — Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Adult Inpatients With Community Acquired Pneumonia — Black or African American | 203 | 209 | 412 |
| Adult Inpatients With Community Acquired Pneumonia — White | 81 | 89 | 170 |
| Adult Inpatients With Community Acquired Pneumonia — More than one race | 3 | 2 | 5 |
| Adult Inpatients With Community Acquired Pneumonia — Unknown or Not Reported | 12 | 20 | 32 |
| Pediatric Inpatients With Community Acquired Pneumonia — American Indian or Alaska Native | 0 | 0 | 0 |
| Pediatric Inpatients With Community Acquired Pneumonia — Asian | 21 | 23 | 44 |
| Pediatric Inpatients With Community Acquired Pneumonia — Native Hawaiian or Other Pacific Islander | 1 | 0 | 1 |
| Pediatric Inpatients With Community Acquired Pneumonia — Black or African American | 130 | 117 | 247 |
| Pediatric Inpatients With Community Acquired Pneumonia — White | 171 | 158 | 329 |
| Pediatric Inpatients With Community Acquired Pneumonia — More than one race | 19 | 19 | 38 |
| Pediatric Inpatients With Community Acquired Pneumonia — Unknown or Not Reported | 71 | 70 | 141 |
| Adult Outpatients With Pharyngitis — American Indian or Alaska Native | 1 | 4 | 5 |
| Adult Outpatients With Pharyngitis — Asian | 74 | 152 | 226 |
| Adult Outpatients With Pharyngitis — Native Hawaiian or Other Pacific Islander | 3 | 4 | 7 |
| Adult Outpatients With Pharyngitis — Black or African American | 312 | 550 | 862 |
| Adult Outpatients With Pharyngitis — White | 1477 | 2724 | 4201 |
| Adult Outpatients With Pharyngitis — More than one race | 24 | 40 | 64 |
| Adult Outpatients With Pharyngitis — Unknown or Not Reported | 141 | 290 | 431 |
| Pediatric Outpatients With Acute Otitis Media — American Indian or Alaska Native | 4 | 0 | 4 |
| Pediatric Outpatients With Acute Otitis Media — Asian | 205 | 210 | 415 |
| Pediatric Outpatients With Acute Otitis Media — Native Hawaiian or Other Pacific Islander | 3 | 8 | 11 |
| Pediatric Outpatients With Acute Otitis Media — Black or African American | 1056 | 949 | 2005 |
| Pediatric Outpatients With Acute Otitis Media — White | 7381 | 6087 | 13468 |
| Pediatric Outpatients With Acute Otitis Media — More than one race | 314 | 330 | 644 |
| Pediatric Outpatients With Acute Otitis Media — Unknown or Not Reported | 1204 | 1157 | 2361 |
PDFs hosted by the registry, ClinicalTrials.gov.
Plan to share: No — This study was initiated prior to the NIH Data Management and Sharing Policy update that was released on January 25, 2023.
Ran from Oct 2022 to primary completion in Jun 2024, 20 months.
Results were first posted in Nov 2025, 1 year 4 months after primary completion.
Of 42 non-industry interventional studies with no phase under Community-Acquired Pneumonia, half reached primary completion within 24 months of starting (the median), counting those still running; a quarter within 15 and three quarters within 38. This study's 20 months is below that.
Counting every sponsor, half of 43 studies reached it within 24 months; a quarter within 14 and three quarters within 38.
How these figures are worked out, and which studies are left out of them.
This study is completed, as verified in Oct 2025. You cannot join it, but the record below documents what was studied.
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Community-Acquired Pneumonia →
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